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Evaluation of a new sitting concept designed for prevention of pressure ulcer on the buttock using finite element analysis

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Abstract

Excessive compressive load induces pressure related soft tissue damage, i.e. pressure ulcer (PU), in buttock area in wheelchair users. In solving this problem, our previous study has introduced a concept of Off-Loading sitting, which partially removes the ischial support to reduce pressure under buttocks. However, the effect of this sitting concept has only been evaluated using the interface pressure and tissue perfusion measurements. The objective of this investigation was to evaluate the Off-Loading posture for its ability to reduce internal pressure and stress in deep buttock tissues. This evaluation was performed on a 3D finite element (FE) model which was established and validated in a sitting posture and has realistic material properties and boundary conditions. FE analysis in this study confirmed that the pressure relief provided by Off-Loading posture created profound effect in reducing the mechanical stress within deep tissues. It was concluded that Off-Loading posture may prove beneficial in preventing sitting related PU.

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References

  1. Ankrom MA, Bennett RG, Sprigle S, Langemo D, Black JM, Berlowitz DR, Lyder CH (2005) National pressure ulcer advisory panel. Pressure-related deep tissue injury under intact skin and the current pressure ulcer staging systems. Adv Skin Wound Care 18:35–42

    Article  Google Scholar 

  2. Bain DS, Ferguson-Pell M (2002) Remote monitoring of sitting behavior of people with spinal cord injury. J Rehabil Res Dev 39:513–520

    Google Scholar 

  3. Best T, McElhaney J, Garrett WJ, Myers B (1994) Characterization of the passive responses of live skeletal muscle using the quasi-linear theory of viscoelasticity. J Biomech 27:419–419

    Article  Google Scholar 

  4. Bouten CV, Oomens CW, Baaijens FP, Bader DL (2003) The etiology of pressure ulcers: skin deep or muscle bound? Arch Phys Med Rehabil 84:616–619

    Article  Google Scholar 

  5. Brosh T, Arcan M (2000) Modeling the body/chair interaction: an integrative experimental-numerical approach. Clin Biomech (Bristol, Avon) 15:217–219

    Article  Google Scholar 

  6. Chow W, Odell E (1978) Deformation and stress in soft body tissue of a sitting person. J Biomech Eng 100:79–87

    Google Scholar 

  7. Dabnichki P, Crocombe A, Hughes S (1994) Deformation and stress analysis of supported buttock contact. Proc Inst Mech Eng 208:9–17

    Google Scholar 

  8. Daniel RK, Priest DL, Wheatley DC (1981) Etiologic factors in pressure sores: an experimental model. Arch Phys Med Rehabil 62:492–498

    Google Scholar 

  9. Gawron CL (1994) Risk factors for and prevalence of pressure ulcers among hospitalized patients. J Wound Ostomy Continence Nurs 21:232–240

    Google Scholar 

  10. Johnson G, Tramaglini D, Levine R, Ohno K, Choi K, Choi N, Woo S (1994) Tensile and viscoelastic properties of human patellar tendon. J Orthop Res 12:796–803

    Article  Google Scholar 

  11. Kuroda S, Akimoto M (2005) Finite element analysis of undermining of pressure ulcer with a simple cylinder model. J Nippon Med Sch 72:174–178

    Article  Google Scholar 

  12. Lim D, Lin F, Hendrix R, Makhsous M (2006) Finite element analysis for evaluation of internal mechanical responses in buttock structure in a true sitting posture: development and validation. RESNA 29th International conference, June 22–26

  13. Linder-Ganz E, Gefen A (2004) Mechanical compression-induced pressure sores in rat hindlimb: muscle stiffness, histology, and computational models. J Appl Physiol 96:2034–2049

    Article  Google Scholar 

  14. Linder-Ganz E, Shabshin N, Itzchak Y, Gefen A (2007) Assessment of mechanical conditions in sub-dermal tissues during sitting: a combined experimental-MRI and finite element approach. J Biomech 40:1443–1454

    Article  Google Scholar 

  15. Makhsous M, Lim D, Hendrix R, Bankard J, Rymer WZ, Lin F (2007) Finite element analysis for evaluation of pressure ulcer on the buttock: development and validation. IEEE Trans Neural Syst Rehabil Eng (in press)

  16. Makhsous M, Rowles DW, Rymer WZ, Bankard J, Nam EK, Chen D, Lin F (2007) Periodically relieving ischial sitting load to decrease the risk of pressure ulcers. Arch Phys Med Rehabil 88:862–870

    Article  Google Scholar 

  17. National Spinal Cord Injury Statistical Center (NSCISC) (2005) Model spinal cord injury care systems. Annu Rep Model Spinal Cord Inj Care Syst

  18. Nola GT, Vistnes LM (1980) Differential response of skin and muscle in the experimental production of pressure sores. Plast Reconstr Surg 66:728–733

    Article  Google Scholar 

  19. Oomens CW, Bressers OF, Bosboom EM, Bouten CV, Blader DL (2003) Can loaded interface characteristics influence strain distributions in muscle adjacent to bony prominences? Comput Methods Biomech Biomed Eng 6(3):171–180

    Article  Google Scholar 

  20. Palevski A, Glaich I, Portnoy S, Linder-Ganz E, Gefen A (2006) Stress relaxation of porcine gluteus muscle subjected to sudden transverse deformation as related to pressure sore modeling. J Biomech Eng 128:782–787

    Article  Google Scholar 

  21. Pinto J, Patitucci P (1980) Visco-elasticity of passive cardiac muscle. J Biomech Eng 102:57–61

    Google Scholar 

  22. Setton L, Zhu W, Mow V (1993) The biphasic poroviscoelastic behavior of articular cartilage: role of the surface zone in governing the compressive behavior. J Biomech 26:581–592

    Article  Google Scholar 

  23. Todd BA, Thacker JG (1994) Three-dimensional computer model of the human buttocks, in vivo. J Rehabil Res Dev 31:111–119

    Google Scholar 

  24. Torres-Moreno R, Jones D, Solomonidis SE, Mackie H (1999) Magnetic resonance imaging of residual soft tissues for computer-aided technology applications in prosthetics—a case stud. J Prosthet Orthot 11:6–11

    Article  Google Scholar 

  25. Woo S, Gomez M, Akeson W (1981) The time and history dependent viscoelastic properties of the canine medial collateral ligaments. J Biomech Eng 103:293–298

    Article  Google Scholar 

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Acknowledgments

The project was supported in part by Falk Medical Research Trust. The authors wish to thank Dr. Kenneth Shull for sharing his knowledge and experience in soft material modeling.

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Correspondence to Mohsen Makhsous.

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Lim, D., Lin, F., Hendrix, R.W. et al. Evaluation of a new sitting concept designed for prevention of pressure ulcer on the buttock using finite element analysis. Med Bio Eng Comput 45, 1079–1084 (2007). https://doi.org/10.1007/s11517-007-0261-3

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  • DOI: https://doi.org/10.1007/s11517-007-0261-3

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